By Richard Harkness
Enquirer contributor

Question: I'm a 44-year-old, badly overweight male. I'm tempted to try the Atkins diet to lose weight. Does it work and is it safe?

Answer: Millions of other Americans, young and old, share your quandary in this era of escalating obesity and its adverse health consequences.

Atkins is now called the Atkins Nutritional Approach, stressing that it is a lifestyle change. It's useful to compare Atkins to more conventional weight-loss diets.

In both approaches, simple carbohydrates are taboo, such as sugar, white flour and white rice, which cause quick rises in insulin levels. Also to be avoided are other processed foods and hydrogenated fats (a "mutant" form of saturated fat). Think "junk food."

And both approaches recommend regular exercise to augment the dietary strategy.

Now we come to the fork in the road: how the two approaches differ.

The conventional approach restricts fat, particularly saturated fats, and allows plenty of complex carbohydrates (grains, veggies and fruits). You count fat grams and calories.

In direct contrast, Atkins restricts complex carbohydrates and allows plenty of cholesterol and fats, including the saturated type (meat, eggs, cheese and butter). You count carbohydrate grams but not calories.

The Atkins approach is controversial because it goes against what we've had drummed into us: avoid excessive dietary fats.

However, Atkins is based on the bedrock physiologic principle that under normal conditions, the body uses food as fuel in this order: carbohydrates, fats and proteins. Deny the body carbohydrates and it breaks down fats to meet its energy needs, thus promoting loss of body fat and weight.

Though you're eating even more fat that usual, fat is continually being broken down for energy, helping prevent its storage by the body.

There's little argument that the Atkins approach efficiently promotes weight loss and that it appears to have beneficial effects on diabetes, cholesterol and triglycerides, heart disease and hypertension, at least in the shorter term.

The primary concern with Atkins is the long-term consequences of doing an end run around carbohydrates.

Will the heart- and diabetes-related benefits falter over time?

Critics point out that, with the cutback in dietary carbohydrates, you're losing the primary source of natural phytochemicals thought to protect against cancer and other diseases.

It is true that, initially, you're restricted to fewer than 20 grams of carbohydrates a day (about two-thirds of an ounce).

Later, however, you can gradually add more complex carbohydrates (up to the point you begin regaining weight). Atkins recommends nutrient-dense, green, leafy vegetables and fruits such as strawberries, which provide both phytochemicals and fiber.

Another concern with Atkins is the effect on the bones and kidneys. Short term, the kidneys seem able to adapt to the required bodily changes, but long-term effects are hazy.

Once you reach the point where your trousers need belt-tightening to keep from falling down, you have a great incentive to stay on track.

However, the problem with dietary weight-loss programs is getting started and sticking with it. In this light, Atkins can be very appealing.

For those who are morbidly obese, the Atkins approach to weight loss should produce immediate health benefits that may outweigh other considerations.

If you opt for Atkins, have your doctor check your kidney function and monitor you regularly.

It might be worth considering a two-part strategy: Use Atkins initially to get to a proper body weight, then gradually add more complex carbohydrates and reduce saturated fats.

Getting regular exercise should allow you to add more carbohydrates.

E-mail rharkn@aol.com.